Bone clip with resilient arm for proximal compression

ABSTRACT

Devices and methods for stabilizing bone. The devices and methods may provide a more balanced proximal and distal compression when stabilizing bone. An exemplary device may comprise a staple member including a bridge connecting a first leg to a second leg. The device also may comprise a resilient arm elongated between a fixed end and a free end, and projecting from the first leg and/or from an end region of the bridge adjoining the first leg. At least a portion of the resilient arm intermediate the fixed and free ends may be inwardly adjacent and spaced from an upper region of the first leg.

INTRODUCTION

A bone clip, also called a bone staple, is a fastener for stabilizingbone. The clip may be installed in one or more bones to span adiscontinuity in the bone(s), such as a fracture, a cut, or ananatomical joint. Once installed, the clip applies compression acrossthe discontinuity, to encourage healing and/or fusion.

An exemplary bone clip 20 representing the prior art is shown in FIGS. 1and 2, respectively during and after insertion into a bone 22. The bonehas a fracture 24 that creates bone fragments 26, 28. Clip 20 has a pairof serrated legs 30 connected to one another with a bridge 32. Legs 30extend along convergent paths from bridge 32 when clip 20 is in anundeformed, relaxed configuration (not shown). Clip 20 is composed of anelastically deformable material, which allows the clip to be placed andheld temporarily in a stressed configuration with an insertion tool 34.For example, tool 34 may have upper and lower jaws 36, 38 that apply abending moment to bridge 32, which reorients legs 30 to be substantiallyparallel to another in the stressed configuration shown in FIG. 1. Tool34 maintains clip 20 in the stressed configuration while legs 30 arebeing inserted, indicated at 40, into parallel, pre-drilled holes 42 infragments 26, 28.

FIG. 2 shows clip 20 after legs 30 have been fully inserted into holes42, and insertion tool 34 has been removed. Clip 20 acts as a springclamp, with legs 30 as jaws. The legs urge bone fragments 26, 28 towardone another as energy stored in the stressed configuration of clip 20 isreleased, to apply compression across fracture 24. However, this designdoes not apply compression uniformly along fracture 24. Instead, asshown in FIG. 2, the amount of compression is related to the distancefrom bridge 32, with distal compression 44 between the free ends of legs30 being significantly greater than proximal compression 46. Thisdifference in compressive force is indicated by force arrows ofdifferent size and a residual gap proximally at the fracture site. Animproved bone clip is needed.

SUMMARY

The present disclosure provides devices and methods for stabilizingbone. The devices and methods may provide a more balanced proximal anddistal compression when stabilizing bone. An exemplary device maycomprise a staple member including a bridge connecting a first leg to asecond leg. The device also may comprise a resilient arm elongatedbetween a fixed end and a free end, and projecting from the first legand/or from an end region of the bridge adjoining the first leg. Atleast a portion of the resilient arm intermediate the fixed and freeends may be inwardly adjacent and spaced from an upper region of thefirst leg.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a fragmentary, sectional view of a fractured bone taken duringinstallation of a bone clip representing the prior art, with legs of thebone clip being advanced into pre-drilled holes in the bone, and withthe bone clip held in an elastically deformed, stressed configuration byan exemplary insertion tool.

FIG. 2 is a fragmentary, sectional view of the fractured bone of FIG. 1taken after installation of the bone clip has been completed and showinguneven compression along the fracture of the bone.

FIG. 3 is a front view of an exemplary bone clip in a relaxedconfiguration, with the bone clip having a pair of resilient armsprojecting from respective legs and configured to provide more balancedcompression of bone.

FIG. 3A is an isometric view of the bone clip of FIG. 3.

FIG. 4 is a front view of the bone clip of FIG. 3 being held in anelastically deformed configuration by an exemplary insertion tool (shownas fragmentary).

FIGS. 5-8 are a series of sectional, fragmentary views of the fracturedbone of FIG. 1 each taken during (FIGS. 5-7) or after (FIG. 8)installation of the bone clip of FIGS. 3, 3A, and 4 using the insertiontool of FIG. 4.

FIG. 9 is a fragmentary, sectional view of a fractured bone taken afterinstallation of the bone clip of FIGS. 3, 3A, and 4 in different holesthan in FIGS. 5-8.

FIG. 10 is a fragmentary front view of an exemplary bone clip having aresilient arm that projects away from the bridge of the bone clip.

FIG. 11 is a fragmentary front view of an exemplary bone clip having aspring member that is fixed at both ends.

FIG. 12 is a fragmentary front view of an exemplary bone clip having apair of resilient arms associated with the same leg.

FIG. 13 is a fragmentary isometric view of another exemplary bone cliphaving a pair of resilient arms associated with the same leg.

FIG. 14 is a fragmentary isometric view of an exemplary bone clip havinga resilient arm that projects from a slot defined by an associated leg.

FIG. 15 is an isometric view of an exemplary bone clip having fourcoplanar legs each associated with a resilient arm.

FIG. 16 is an isometric view of an exemplary bone clip having atriangular arrangement of three legs each associated with a resilientarm.

FIG. 17 is an isometric view of an exemplary bone clip having arectangular arrangement of four legs each associated with a resilientarm.

FIG. 18 is an isometric view of an exemplary multi-piece bone cliphaving a pair of hinged elongate members.

FIG. 19 is a front view of an exemplary bone clip arranged in a stressedconfiguration (i.e., with its legs parallel to one another) and having apair of resilient arms and a slanted bridge.

FIG. 20 is a front view of an exemplary bone clip arranged in a stressedconfiguration (i.e., with its legs parallel to one another) and having apair of resilient arms and a stepped bridge.

DETAILED DESCRIPTION

The present disclosure provides devices and methods for stabilizingbone. The devices and methods may provide a more balanced proximal anddistal compression when stabilizing bone. An exemplary device maycomprise a staple member including a bridge connecting a first leg to asecond leg. The device also may comprise a resilient arm elongatedbetween a fixed end and a free end, and projecting from the first legand/or from an end region of the bridge adjoining the first leg. Atleast a portion of the resilient arm intermediate the fixed and freeends may be inwardly adjacent and spaced from an upper region of thefirst leg.

Another exemplary device for stabilizing bone is provided. The devicemay comprise a staple member including a bridge connecting a first legto a second leg. The device also may comprise an arm inwardly adjacentand pivotally connected to an upper region of the first leg. The arm maybe firmly attached to a lower region of the first leg.

An exemplary method for stabilizing bone with the device is provided. Inthe method, a first hole and a second hole are drilled in bone. Thefirst leg and the arm of the device may be inserted into the first hole,and the second leg of the device may be inserted into the second hole.

Further aspects of the present disclosure are described in the followingsections: (I) overview of bone clips for proximal compression, (II)methods of stabilizing bone with bone clips, and (III) examples.

I. OVERVIEW OF BONE CLIPS FOR PROXIMAL COMPRESSION

This section provides an overview of bone clips that provide proximalcompression using at least one spring member and/or arm, as exemplifiedby bone clip 50; see FIGS. 3, 3A, and 4.

Bone clip 50 is shown in a relaxed configuration in FIGS. 3 and 3A, andin a stressed configuration in FIG. 4. Clip 50 includes a staple member52 having a bridge 54 joined to and interconnecting a pair of legs 56.Each leg 56 has an upper end 58 (interchangeably called a proximal end)that forms a junction with bridge 54, and a lower end 60(interchangeably called a distal end) that is farthest from bridge 54.The terms “upper” and “lower,” and “proximal” and “distal,” are definedby relative proximity to bridge 54, with upper and proximal being closerto the bridge than lower and distal. The terms “inner” and “outer” arerespectively closer to and farther from a central plane and/or centralaxis, as defined below. In other embodiments, bone clip 50 may have atleast three or at least four legs 56 (e.g., see Example 2 of SectionIII).

A spring member 62 may be associated with at least one leg 56, orrespective spring members 62 may be associated with at least two legs,such as each leg 56 as in the depicted embodiment. More specifically,each spring member 62 may project from one of legs 56 and/or from an endregion of bridge 54 adjoining the leg. In the depicted embodiment, eachspring member 62 is an arm 64 that projects proximally from leg 56 andhas a distal fixed end 66 and a proximal free end 68. Arm 64 may bedescribed as a resilient arm (i.e., the arm is elastically deformable,which allows the arm to function as a spring, such as a cantileverspring). In other embodiments, fixed end 66 is proximal and free end 68is distal, both ends of spring member 62 are fixed ends, and/or springmember 62 includes a pair of resilient arms 64 associated with one oflegs 56 (see Example 1 of Section III). In other embodiments, the boneclip includes a plurality of discrete pieces that are pivotablyconnected to one another (see Example 3 of Section III).

Spring member 62 and/or arm 64 may have any suitable properties. Atleast a portion 70 of spring member 62 and/or arm 64 intermediate itsends may be located inwardly adjacent and spaced from an upper region 72of associated leg 56. The term “inward” as used herein means at leastgenerally toward a different leg(s) 56 of bone clip 50, and/or at leastgenerally toward a central plane 74 (and/or a central axis 75) thatintersects bridge 54 and is centered between legs 56. The terms “inner”and “outer” are respectively closer to and farther from central plane 74or axis 75. For example, in the depicted embodiment, each leg 56 has aserrated inner side and a smooth outer side.

Portion 70 (and/or free end 68) may be spaced from upper region 72 ofassociated leg 56 by any suitable distance, such as less than about 25%,20%, or 15% of the maximum distance between legs 56, and/or more thanabout 2%, 3%, 4% or 5% of this maximum distance. A larger spacing may bepreferable in some cases, in order to maintain compression dynamicallyas bone is resorbed from the interface between bone fragments and/orbones.

The spring member and/or arm may be elongated between ends thereof todefine a longitudinal axis, which may be linear or curved, among others.The curvature may, for example, be convex with respect to central plane74 and/or axis 75, as in the depicted embodiment. A curved longitudinalaxis may be preferred in some cases, as it may offer the spring memberand/or arm two distinct spring constants, namely, a first springconstant for closing the gap, if any, between free end 68 and upperregion 72, and a second spring constant for reducing the curvature, ifany, of the spring member and/or arm.

Legs 56 may extend convergently from bridge 54 when bone clip 50 is in arelaxed configuration, as shown in FIGS. 3 and 3A. In other words, upperends 58 of legs 56 may be significantly farther from one another thanlower ends 60 are to one another. Each leg may form any suitable anglewith a respective plane that is parallel to central plane 74 (and/orwith a respective axis that is parallel to central axis 75), such as atleast about 5 or 10 degrees, and/or about 5-25 degrees or 10-20 degrees,among others. Legs 56 may form angles of the same size with the planesand/or axes.

Legs 56 may be substantially parallel to one another, as in FIG. 4, whenbone clip 50 is being held in a stressed configuration by an insertiontool 34, before or during insertion into bone. Insertion tool 34 mayengage only bridge 54 of bone clip 50 (as in FIG. 1) to apply deformingstress. In other embodiments, insertion tool 34 may engage bridge 54 andlegs 56, or legs 56 alone, of the bone clip.

In some embodiments, bone clip 50 may have one or more protrusions, suchas tabs 76, to facilitate operative engagement of insertion tool 34 withbone clip 50. Each protrusion may project from any suitable position ofstaple member 52, such as the top side of bridge 54, as shown here,longitudinally from bridge 54 at an end thereof, the front and/or backside of bridge 54, the bottom side of bridge 54, and/or one of legs 56.Each protrusion may be configured to be detached from staple member 52,such as by breaking off or cutting the protrusion from the staplemember, or the protrusion may be sized and positioned to remain attachedto staple member 52 after bone clip 50 has been implanted in a subject.

Insertion tool 34 may deform bridge 54 by applying a bending moment tostaple member 52. Bridge 54 may be bowed upward (or straight) in therelaxed configuration of staple member 52, as shown in FIG. 3, and maybe less curved and/or bowed downward in the stressed configuration ofstaple member 52, as shown in FIG. 4. Insertion tool 34 may create thebending moment by applying downward stress centrally along bridge 54,and upward stress closer to the ends of bridge 54. For example, in thedepicted embodiment, insertion tool 34 has a pair of limbs 78 withrespective cutouts 80 that mate with tabs 76. Limbs 78 then are rotatedtoward one another, which causes a toe 82 of each limb 78 to pressdownward on a central region of bridge 54, while a wall of each cutout80 pulls upward on one of tabs 76. Limbs 78 then may be locked to oneanother, to maintain bone clip 50 in the stressed configuration of FIG.4 until legs 56 have been inserted into bone.

Each arm 64 may be closer than its associated leg 56 to central plane 74and/or axis 75 when bone clip 50 is in the stressed configuration ofFIG. 4. In other words, a minimum distance 84 between arm 64 and plane74 and/or axis 75 may be less than a minimum distance 86 between leg 56and plane 74 and/or axis 75. Insertion of bone clip 50 into bone, whilethe bone clip is held in the stressed configuration of FIG. 4, mayincrease distance 84 by elastically deforming at least one arm 64, asdescribed further below.

The bone clips of the present disclosure may have any suitableconstruction and composition. Each bone clip may be formed as only onepiece (i.e., a unitary construction), as in FIG. 3, or may include twoor more discrete pieces that are movably connected to one another (e.g.,see Example 3 of Section III). Any combination of bridge 54, legs 56,spring member(s) 62 (and/or arm(s) 64), and tabs 76 (if any) may beformed integrally with one another. The bone clip may be formed of anysuitable biocompatible material, such as metal (stainless steel,titanium, titanium alloy, cobalt chrome, magnesium, magnesium alloy,etc.), polymer, or the like. In some embodiments, the bone clip may becomposed of nickel titanium, also known as Nitinol, which is an alloy ofnickel and titanium, generally in roughly equal amounts. Nickel titaniummay be described as a shape memory alloy.

Bone clip 50 may have a uniform thickness measured between a front side88 and a back side 90 (see FIG. 3A). Sides 88, 90 may be substantiallyplanar surfaces that are parallel to one another. Accordingly, the boneclip may be manufactured by cutting the clip from a flat plate. Thethickness of bone clip 50 may be greater than, about the same as, orless than, the average width of bridge 54 and/or each leg 56 (measuredin a plane defined the bridge and legs). For example, the thickness maybe at least about 25% of the average width of the bridge and/or eachleg.

Further aspects of bone clip 50 that may be suitable are describedelsewhere herein, such as in Sections II and III.

II. METHODS OF STABILIZING BONE WITH BONE CLIPS

This section describes exemplary methods of stabilizing bone with thebone clips of the present disclosure, as exemplified with bone clip 50of FIGS. 3, 3A, and 4 having two legs 56 each associated with aresilient arm 64; see FIGS. 4-9. The steps described here can beperformed in any suitable order and combination using any of the boneclips of the present disclosure.

Bone to be stabilized may be selected. The bone may be a single bone 22or at least a pair of adjacent bones (e.g., to be fused to one another).If a single bone, the bone may have a fracture 24 (as shown in FIG. 5),a cut (for an osteotomy), a structural weakness, or the like. Exemplarybones that may be suitable include long bones of the arm (humerus, ulna,and/or radius), bones of the hand (carpals, metacarpals, and/orphalanges), long bones of the leg (femur, tibia, and/or fibula), bonesof the foot (talus, calcaneus, tarsals, metatarsals, and/or phalanges),the pelvis, ribs, the sternum, vertebrae, clavicles, scapulas, or thelike. The bone may be stabilized temporarily by the bone clip, onlyduring a surgical procedure, or more permanently for any suitable amountof time after the bone clip has been implanted in a subject.Accordingly, the bone clip may be used for fracture fixation, osteotomyfixation, fusion of bones of an anatomical joint, temporary reduction,or the like.

A bone clip may be selected for stabilizing the bone. The bone clip mayhave two legs, or three or more legs. The size of the bone clip may bechosen according to the size of bone to be stabilized and the magnitudeof loads to be exerted on the bone once stabilized.

Holes 42 may be drilled in the selected bone. A separate hole 42 may bedrilled to receive each leg 56 of bone clip 50. Each hole may beslightly deeper than the length of leg 56 to be received. The holes maybe positioned such that a discontinuity in the selected bone (e.g.,fracture 24) is intermediate a pair of legs 56 of the clip. Each hole 42may be drilled generally normal to the local exterior surface of theselected bone, and the holes may be drilled parallel to one another. Theholes may be drilled after pieces of bone are aligned and surfacesthereof (e.g., fracture or cut surfaces 92, 94) are approximated,although a small gap 96 between fragments 26, 28 may be present. Holes42 may be spaced from one another such that a minimum distance 98between the holes substantially matches a minimum distance 100 betweenlegs 56. A minimum distance 102 between arms 64 is generally less thandistance 98 (and distance 100). Each hole 42 may have a diameter D₁, andbone clip 50 may define a collective, relaxed maximum width D₂ of thecorresponding leg 56 and arm 64, measured in a plane defined by the boneclip. Generally, D₁≥D₂.

Bone clip 50 may be deformed to a stressed configuration with insertiontool 34. The insertion tool may hold the bone clip in the stressedconfiguration until legs 56 of bone clip 50 are substantially fullyinserted into respective holes 42, as shown in FIGS. 6 and 7. As shownin FIG. 7, the process of insertion may cause arms 64 to move fartherapart from one another by deformation (to increase distance 102 relativeto FIG. 5). Since a small gap 96 between bone fragments or bones may bepresent at the start of insertion, bone fragments 26, 28 also may bemoved closer together (to decrease distance 98 proximally (see FIG. 5)).This movement may be produced by force exerted on the near sides 104 ofholes 42 by arms 64 as the proximal portions of legs 56 and theiradjacent arms 64 are inserted into holes 42 (see FIG. 7). The gap, ifany, between bone fragments 26, 28 may be closed only proximally, inresponse to proximal compression 106 applied by arms 64. The arms may becompressed toward their associated legs 56 by contact with near side 104of each hole 42. As a result, the collective width corresponding to D₂may be reduced (also see FIG. 5).

FIG. 8 shows bone clip 50 in a fully installed configuration. Insertiontool 34 has been removed, and tabs 76 have been detached from bridge 54.Legs 56 have moved closer to one another, to decrease distance 100,which results in distal compression 107.

Compression may be more uniform along fracture 24 than with bone clipsof the prior art (e.g., see FIGS. 1 and 2). Furthermore, bone clip 50can continue to apply proximal and distal compression 106, 107 if boneresorption occurs around fracture 24 during healing. This resorption mayfurther decrease distance 98 (also see FIG. 5), as arms 64 expand inwardfrom legs 56 to apply proximal compression dynamically. (This expansionincreases the collective width measured between the outer side of leg 56and the inner side of corresponding arm 64.) The outer sides of legs 56do not contact the far sides 108 of holes 42, even if arms 64 return totheir relaxed configurations, when D₁>D₂.

FIG. 9 shows bone clip 50 installed in holes 42 that have been widenedproximally, but selectively at far sides thereof, indicated at 110. Thiswidening may be performed with a punch, before or after bone clip 50 hasbeen installed. The use of a punch or similar tool allows distance 98 toremain the same, while increasing the diameter of hole 42 proximally toaccommodate a greater amount of bone resorption (and thus a greaterdistance of travel of the bone fragments toward one another).Accordingly, a smaller total volume of bone can be removed relative todrilling wider holes 42 at the outset.

III. EXAMPLES

This section describes selected embodiments of bone clips forstabilizing bone and methods of using the bone clips to stabilize bone.Any of the features of the devices and methods described in this sectionmay be combined with one another and with any of the features describedelsewhere in the present disclosure, in any suitable combination. Theseembodiments are intended for illustration and should not limit theentire scope of the present disclosure.

Example 1. Spring Member Configurations

This example describes exemplary alternative spring memberconfigurations for incorporation into bone clip 50 of FIGS. 3, 3A, and4-9; see FIGS. 10-14. Only one leg 56 and an end region of bridge 54 areshown for each embodiment. Each other leg 56 of the clip may (or maynot) be associated with a spring member, optionally similar to what isshown.

FIG. 10 shows a bone clip 50 having a spring member 62 in the form of aresilient arm 64 projecting distally from bridge 54. A fixed end 66 ofarm 64 is located at the junction between bridge 54 and leg 56, and afree end 68 of the arm is located distally therefrom, closer to lowerend 60 of leg 56.

FIG. 11 shows a bone clip 50 having a spring member 62 with no free end.

Instead, both ends are fixed to staple member 52.

FIG. 12 shows a bone clip 50 having a spring member 62 formed by a pairof resilient arms 64 a, 64 b. Each arm 64 a, 64 b has a fixed end 66 anda free end 68. Arm 64 a projects distally from bridge 54, and arm 64 bprojects proximally from leg 56.

FIG. 13 shows a bone clip 50 having a pair of resilient arms 64 a, 64 beach extending proximally from leg 56 to a free end 68 that is closer tobridge 54. The arms are attached to front side 88 and back side 90,respectively, of leg 56, and may be offset transversely from staplemember 52.

FIG. 14 shows a bone clip 50 having a resilient arm 64 projectingproximally from a slot 112 defined by a leg 56. Slot 112 may be sized topermit at least part of arm 64 to move into the slot as the arm isdeformed.

Example 2. Bone Clips with at Least Three Legs

This example describes exemplary bone clips 50 having at least threelegs and including a spring member and/or resilient arm to applyproximal compression to bone; see FIGS. 15-17.

FIG. 15 shows a bone clip 50 having four coplanar legs 56 eachassociated with a respective resilient arm 64. In other embodiments,only a subset of legs 56 are associated with a resilient arm 64.

FIG. 16 shows a bone clip 50 having a triangular arrangement of threelegs 56 each associated with a resilient arm 64. In other embodiments,only a subset of legs 56 are associated with a resilient arm 64.

FIG. 17 shows a bone clip 50 having a rectangular arrangement of fourlegs 56 each associated with a resilient arm 64. In other embodiments,only a subset of legs 56 are associated with a resilient arm 64.

Example 3. Bone Clip with Pivotally Connected Members

This example describes an exemplary bone clip 120 including at least onepivotally connected elongate member 122; see FIG. 18.

Bone clip 120 includes a staple member 52 having a bridge 54 connectinga pair of legs 56 to one another. Bridge 54 and a pair of upper legregions 124 are formed by a body 126, which may be only one piece. Arespective elongate member 122 is pivotally connected at a pivotablejoint 128 to a distal end of each upper leg region 124. Elongate member122 forms a lower leg region 130 of one of legs 56 and also forms an arm132. However, arm 132 may be substantially less deformable than arm 64of bone clip 50. Arm 132 may be firmly attached to lower leg region 130(e.g., formed integrally with the lower leg region), and may extendproximally from pivotable joint 128 to a proximal end 134.

Bone clip 120 may be installed as described above in Section II for boneclip 50. However, pivotal motion of each elongate member 122, ratherthan elastic deformation of an arm with respect to an associated leg,provides balanced proximal and distal compression.

Example 4. Bone Clip with Resilient Arms and a Slanted or Stepped Bridge

This example describes exemplary bone clips 50 having a slanted bridge54 (FIG. 19) or a stepped bridge 54 (FIG. 20) connecting a pair of legs56 to one another. The bone clips are shown in a stressed configuration(e.g., similar to FIG. 4) with legs 56 parallel to one another, but, forsimplification, in the absence of an insertion tool to produce/maintainthe stressed configuration. Each bone clip 50 may have a respectivespring member 62 and/or resilient arm 64 associated with at least oneleg 56 (or each leg 56 as shown). The bone clips of this example mayhave any suitable combination of features described in the presentdisclosure.

FIG. 19 shows bridge 54 forming an angle of less than 90 degrees with aleg 56 at one end and an angle of greater than 90 degrees with the otherleg. The angles may add up to about 180 degrees when the bone clip is inthe stressed configuration, as shown here. The smaller angle may be lessthan about 85, 80, 75, 70, 65, or 60 degrees, among others, and/orgreater than about 30, 40, 45, 50, or 60 degrees, among others.

FIG. 20 shows bridge 54 forming an angle of about 90 degrees with eachleg 56. However, the bridge bends abruptly intermediate the endsthereof, to form a step, which offsets the legs relative to anotherparallel to a central axis of the clip.

Example 5. Selected Embodiments

This example describes selected aspects of the present disclosure as aseries of indexed paragraphs.

Paragraph 1. A device for stabilizing bone, comprising: (a) a staplemember including a bridge connecting a first leg to a second leg; and(b) a resilient arm elongated between a fixed end and a free end, andprojecting from the first leg and/or from an end region of the bridgeadjoining the first leg, wherein at least a portion of the resilient armintermediate the fixed and free ends is inwardly adjacent and spacedfrom an upper region of the first leg.

Paragraph 2. The device of paragraph 1, wherein the staple member has astressed configuration in which the first and second legs are parallelto one another, and in which a minimum distance between the resilientarm (in its relaxed configuration) and a plane centered between thefirst leg and the second leg is less than a minimum distance between thefirst leg and the plane.

Paragraph 3. The device of paragraph 2, wherein the resilient arm andthe first leg collectively have a maximum width, and wherein theresilient arm is configured to be elastically deformable to reduce themaximum width while the staple member remains in the stressedconfiguration.

Paragraph 4. The device of any of paragraphs 1 to 3, wherein aseparation distance between a portion of the resilient arm and the upperregion of the first leg is configured to decrease by elastic deformationof the resilient arm when the device is installed in bone.

Paragraph 5. The device of any of paragraphs 1 to 4, wherein the fixedend of the resilient arm is farther than the free end from the bridge.

Paragraph 6. The device of any of paragraphs 1 to 5, wherein the staplemember has a relaxed configuration, and wherein the first and secondlegs extend convergently from the bridge along their respectivelongitudinal axes in the relaxed configuration.

Paragraph 7. The device of any of paragraphs 1 to 6, wherein the devicehas a relaxed configuration, wherein a line intersects the fixed end andthe free end of the resilient arm, and wherein the line is within about10, 20, 25, or 30 degrees of parallel to a longitudinal axis of thefirst leg when the device is in the relaxed configuration.

Paragraph 8. The device of any of paragraphs 1 to 7, wherein one of thefixed and free ends of the resilient arm is an upper end and the otherof the fixed and free ends of the resilient arm is a lower end, andwherein the first leg and the resilient arm have a collective widthmeasured from an outer side of the first leg to an inner side of theresilient arm, and wherein the collective width tapers away from thebridge near the lower end of the resilient arm when the device is in arelaxed configuration.

Paragraph 9. The device of any of paragraphs 1 to 8, wherein theresilient arm is spaced from the staple member along an entire length ofthe resilient arm, except at the fixed end, when the device is in arelaxed configuration.

Paragraph 10. The device of any of paragraphs 1 to 9, wherein theresilient arm has a curved longitudinal axis.

Paragraph 11. The device of any of paragraphs 1 to 10, wherein theresilient arm is a first resilient arm, further comprising a secondresilient arm projecting from the second leg and/or from an end regionof the bridge adjoining the second leg.

Paragraph 12. The device of paragraph 11, wherein the staple member hasa stressed configuration in which the first and second legs are parallelto one another, and in which a minimum distance between the firstresilient arm and the second resilient arm is less than a minimumdistance between the first leg and the second leg.

Paragraph 13. The device of paragraph 12, wherein the first resilientarm and the second resilient arm are configured to deform elastically toincrease the minimum distance between the first resilient arm and thesecond resilient arm while the staple member remains in the stressedconfiguration.

Paragraph 14. The device of any of paragraphs 1 to 13, wherein thedevice is composed of a nickel titanium alloy.

Paragraph 15. The device of any of paragraphs 1 to 14, wherein thestaple member defines a plane, and wherein the staple member and theresilient arm have the same thickness as one another orthogonal to theplane.

Paragraph 16. The device of any of paragraphs 1 to 15, wherein thestaple member and the resilient arm are formed integrally with oneanother.

Paragraph 17. The device of any of paragraphs 1 to 16, wherein thedevice is only one discrete piece.

Paragraph 18. The device of any of paragraphs 1 to 17, wherein thestaple member has at least three legs connected to one another by thebridge.

Paragraph 19. The device of any of paragraphs 1 to 18, wherein thedevice is configured to be used for cortical and/or cancellous bone.

Paragraph 20. The device of any of paragraphs 1 to 19, (i) wherein eachleg is located in a hole formed in a bone or bone fragment, and/or (ii)wherein a central axis is centered between the legs, and wherein upperends of the legs are offset relative to one another parallel to thecentral axis, and/or wherein the bridge is slanted and/or stepped toproduce an offset of the upper ends of the legs relative to one anotherparallel to the central axis.

Paragraph 21. A method of stabilizing bone using the device of any ofparagraphs 1 to 20, the method comprising: (i) drilling a first hole anda second hole in bone; and (ii) inserting the first leg and theresilient arm into the first hole, and the second leg into the secondhole.

Paragraph 22. The method of paragraph 21, wherein the step of insertingelastically deforms the resilient arm outward.

Paragraph 23. The method of paragraph 21 or 22, wherein the step ofinserting applies proximal compression to the bone.

Paragraph 24. The method of paragraph 23, wherein the proximalcompression is applied in part by contact between the resilient arm andthe bone at the first hole.

Paragraph 25. The method of paragraph 23 or 24, wherein the device has apair of resilient arms, and wherein the proximal compression is appliedto the bone by the pair of resilient arms at the first and second holes.

Paragraph 26. The method of any of paragraphs 21 to 25, furthercomprising a step of applying distal compression to the bone via contactbetween the first leg and the first hole and between the second leg andthe second hole.

Paragraph 27. The method of paragraph 26, wherein the step of insertingis performed while the staple member is held in a stressed configurationwith an insertion tool, wherein the distal ends of the first and secondlegs are farther apart from one another in the stressed configurationrelative to a relaxed configuration of the staple member, and whereinthe step of applying distal compression includes a step of releasing thestaple member from the insertion tool.

Paragraph 28. The method of any of paragraphs 21 to 27, wherein thefirst and second holes are formed in the same bone, and wherein the samebone has a fracture or a cut intermediate the first and second holes.

Paragraph 29. The method of any of paragraphs 21 to 28, wherein the stepof inserting includes a step of moving a portion of the resilient armcloser to the first leg, and/or a step of moving bone fragments ordifferent bones closer to one another.

Paragraph 30. The method of any of paragraphs 21 to 29, wherein thefirst and second holes have respective near sides that are closer to oneanother than central axes of the holes, and wherein the step ofinserting places the resilient arm in contact with the near side of thefirst hole.

Paragraph 31. The method of paragraph 30, wherein the resilient arm is afirst resilient arm, wherein the device has a second resilient armassociated with the second leg, and wherein the step of inserting placesthe second arm in contact with the near side of the second hole.

Paragraph 32. The method of any of paragraphs 21 to 31, wherein thefirst leg and the resilient arm have a collective width when the deviceis in a relaxed configuration, and wherein the step of inserting reducesthe collective width.

Paragraph 33. A device for stabilizing bone, comprising: (a) a staplemember including a bridge connecting a first leg to a second leg; and(b) an arm inwardly adjacent and pivotally connected to an upper regionof the first leg; wherein the arm is firmly attached to a lower regionof the first leg.

Paragraph 34. The device of paragraph 33, wherein the first leg has apivotable joint formed intermediate a proximal end and a distal end ofthe first leg, and wherein the arm and the lower region of the first legare formed by an elongate member that is rotatable as a unit withrespect to the upper region of the first leg via the pivotable joint.

Paragraph 35. The device of paragraph 33 or 34, wherein the arm and thelower region of the first leg are formed integrally with one another.

Paragraph 36. The device of any of paragraphs 33 to 35, wherein the armis a first arm and the elongate member is a first elongate member,wherein a second elongate member forms a second arm and a lower regionof the second leg and is pivotable with respect to an upper region ofthe second leg.

Paragraph 37. The device of any of paragraphs 33 to 36, wherein thebridge is formed integrally with the upper region of the first leg andwith an upper region of the second leg, and wherein a respectiveelongate member is pivotally connected to a distal end of the upperregion of the first leg and the upper region of the second leg.

The disclosure set forth above may encompass multiple distinctinventions with independent utility. Although each of these inventionshas been disclosed in its preferred form(s), the specific embodimentsthereof as disclosed and illustrated herein are not to be considered ina limiting sense, because numerous variations are possible. The subjectmatter of the inventions includes all novel and nonobvious combinationsand subcombinations of the various elements, features, functions, and/orproperties disclosed herein. The following claims particularly point outcertain combinations and subcombinations regarded as novel andnonobvious. Inventions embodied in other combinations andsubcombinations of features, functions, elements, and/or properties maybe claimed in applications claiming priority from this or a relatedapplication. Such claims, whether directed to a different invention orto the same invention, and whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the inventions of the present disclosure.Further, ordinal indicators, such as first, second, or third, foridentified elements are used to distinguish between the elements, and donot indicate a particular position or order of such elements, unlessotherwise specifically stated.

We claim:
 1. A device for stabilizing a first bone part and a secondbone part, comprising: a staple member including a bridge connecting afirst leg to a second leg; a first resilient arm elongated between afirst fixed end and a first free end, the first fixed end projectingfrom the first leg and/or from an end region of the bridge adjoining thefirst leg, wherein at least a portion of the first resilient armintermediate the first fixed and first free ends is inwardly adjacent toan upper region of the first leg, wherein there is an absence ofmaterial between the at least a portion of the first resilient arm andthe first leg, and wherein the first resilient arm is configured toelastically deform towards, and relative to, the first leg; and a secondresilient arm elongated between a second fixed end and a second freeend, the second fixed end projecting from the second leg and/or from anend region of the bridge adjoining the second leg, wherein the secondresilient arm is configured to elastically deform towards, and relativeto, the second leg, wherein the first resilient arm is positioned withrespect to the first leg and the second resilient arm is positioned withrespect to the second leg such that, while the device is being installedin the first and second bone parts, the first resilient arm and thesecond resilient arm apply a compressive force to the first and secondbone parts thereby closing a gap between the first and second boneparts.
 2. The device of claim 1, wherein the staple member has astressed configuration in which the first and second legs are parallelto one another, and in which a minimum distance between the resilientarm and a plane centered between the first leg and the second leg isless than a minimum distance between the first leg and the plane.
 3. Thedevice of claim 2, wherein the resilient arm and the first legcollectively have a maximum width, and wherein the resilient arm isconfigured to be elastically deformable to reduce the maximum widthwhile the staple member remains in the stressed configuration.
 4. Thedevice of claim 1, wherein a separation distance between a portion ofthe resilient arm and the upper region of the first leg is configured todecrease by elastic deformation of the resilient arm when the device isinstalled in bone.
 5. The device of claim 1, wherein the fixed end ofthe resilient arm is farther than the free end from the bridge.
 6. Thedevice of claim 1, wherein the staple member has a relaxedconfiguration, and wherein the first and second legs extend convergentlyfrom the bridge along their respective longitudinal axes in the relaxedconfiguration.
 7. The device of claim 1, wherein the device has arelaxed configuration, wherein a line intersects the fixed end and thefree end of the resilient arm, and wherein the line is within 30 degreesof parallel to a longitudinal axis of the first leg when the device isin the relaxed configuration.
 8. The device of claim 1, wherein one ofthe fixed and free ends of the resilient arm is an upper end and theother of the fixed and free ends of the resilient arm is a lower end,and wherein the first leg and the resilient arm have a collective widthmeasured from an outer side of the first leg to an inner side of theresilient arm, and wherein the collective width tapers away from thebridge near the lower end of the resilient arm when the device is in arelaxed configuration.
 9. The device of claim 1, wherein the resilientarm is spaced from the staple member along an entire length of theresilient arm, except at the fixed end, when the device is in a relaxedconfiguration.
 10. The device of claim 1, wherein the resilient arm hasa curved longitudinal axis.
 11. The device of claim 1, wherein thestaple member has a stressed configuration in which the first and secondlegs are parallel to one another, and in which a minimum distancebetween the first resilient arm and the second resilient arm is lessthan a minimum distance between the first leg and the second leg. 12.The device of claim 11, wherein the first resilient arm and the secondresilient arm are configured to deform elastically to increase theminimum distance between the first resilient arm and the secondresilient arm while the staple member remains in the stressedconfiguration.
 13. The device of claim 1, wherein the device is composedof a nickel titanium alloy.
 14. The device of claim 1, wherein thestaple member defines a plane, and wherein the staple member and theresilient arm have the same thickness as one another orthogonal to theplane.
 15. The device of claim 1, wherein the staple member and theresilient arm are formed integrally with one another.
 16. The device ofclaim 1, wherein the device is only one discrete piece.
 17. The deviceof claim 1, wherein the staple member has at least three legs connectedto one another by the bridge.
 18. The device of claim 1, wherein thefirst leg is located in a hole formed in the first bone part and thesecond leg is located in a hole formed in the second bone part while thedevice is being installed in bone.
 19. A method of stabilizing boneusing the device of claim 1, the method comprising: selecting the deviceof claim 1; drilling a first hole in the first bone part and a secondhole in the second bone part; and inserting the first leg and the firstresilient arm into the first hole, and the second leg and the secondresilient arm into the second hole.
 20. The device of claim 1, wherein asingle bone includes the first bone part and the second bone part suchthat the gap is a fracture, cut, or structural weakness in the singlebone between the first bone part and the second bone part.
 21. Thedevice of claim 1, wherein the first bone part is a first discrete boneand the second bone part is a second discrete bone.